CPT® Code 37193

Retrieval (removal) of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed

The procedure described by CPT® Code 37193 involves the retrieval or removal of an intravascular vena cava filter using an endovascular approach. This procedure is typically performed when a vena cava filter, which is designed to prevent blood clots from traveling to the lungs, needs to be removed due to various clinical reasons. The process begins with the physician obtaining a cavogram, a type of imaging study, to accurately locate the filter and to check for any clots that may be trapped at the filter site. Access to the vascular system is achieved through either the femoral or jugular vein, where an introducer sheath is placed to facilitate the procedure. Under the guidance of imaging techniques such as ultrasound and fluoroscopy, a guidewire is carefully inserted and navigated through the venous system, reaching the inferior vena cava (IVC). Depending on the access point, the guidewire may traverse through the femoral and iliac veins or, in the case of a jugular approach, through the jugular and brachiocephalic veins, superior vena cava, and right atrium. Once the guidewire is in place, a filter retrieval catheter is advanced over it to reach the filter. The retrieval process involves snaring the hook at the apex of the filter and advancing an outer sheath over the anchoring hooks of the filter struts, disengaging them from the wall of the vena cava. The sheath is then advanced until the filter is fully collapsed and enclosed within it, allowing for safe removal of both the filter and the retrieval set. Following the retrieval, additional cavograms may be performed to assess blood flow and to ensure that there is no trauma to the vena cava or surrounding structures. Finally, the incision made during the procedure, whether in the neck or groin, is closed to complete the process.